NHI will add to SA’s fiscal and healthcare woes

15 January 2020
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Speaking in KwaZulu-Natal on New Year’s Day, Health Minister Zweli Mkhize said that the National Health Insurance (NHI) will put private and public hospitals on par with each other. Indeed, rather than improving the quality of care on offer in the public sector, it’s more likely that, by effectively nationalising them, the NHI will reduce the quality of care at private facilities. 

Despite the national budget not having the resources to fund the NHI, it appears the government is determined to push ahead with its government-centric model of healthcare. The suggestion that NHI should be funded through an increase in taxes, is not fiscally responsible. If anything, to avoid another ratings downgrade later this year, government should be seeking ways to drastically cut spending. The details as to how the NHI is to be funded have yet to be made clear. Introducing more taxes will just be another body-blow to the South African taxpayer, and the economy.

Government’s track record of running any ‘enterprise’ is average at best, and abysmal at worst. We cannot forget stage 6 load shedding, which occurred at the end of 2019, as blackouts continue to grind the economy to a halt. No business, big or small, can operate without a reliable, consistent supply of electricity.

SAMA (South African Medical Association) spokesperson Dr Mvuyisi Mzukwa recently said, “The establishment of the NHI as a single, monopolistic purchaser for health care opens its structures to large-scale corruption.” The spectre of yet more corruption is not something South Africa can contemplate, considering the extensive amount of damage it has already done to the country. SAMA also revealed that a recent survey of its members (it represents around 17,000 doctors) found that up to 40% would consider emigrating if the NHI bill is implemented as it stands.

As soon as any government tries to dictate to doctors, nurses, and specialists, where they may or may not work, they will seek out a different country where they will be welcomed and have more freedom. The massive uncertainty around funding and the practicalities of implementing a centrally controlled and administered NHI scheme, which gives the Minister of Health inordinate amounts of power over the entire healthcare system, will deliver entirely predictable consequences. It will lead to the emigration of more healthcare professionals and will reduce the quality of healthcare provision in the country.

The NHI is not the best method to improve either quality of, or access to, healthcare services for poorer South Africans. The Department of Health would be better served by using its available funding to improve its existing services. The focus should be on improving from the ground up, not on pushing everything down to the same low, inadequate level. The current massive amount of pressure on the public healthcare sector could be relieved if government implemented the policy of providing taxpayer funded healthcare vouchers for poorer citizens to use yet leave them free to choose whether to purchase healthcare services from either the public or private sector. 

The problems of socialised healthcare have been hidden by the rhetoric surrounding the NHI.  When people can only get their healthcare services through the government, the pressure increases, inflating problems such as long waiting lines, and lack of quality in terms of service provision. The inevitable bureaucracy and inefficiency of government involvement, a hallmark of government projects in South Africa, will not resolve SA’s healthcare problems.

Minister Mkhize’s goal might well be to align the level of quality of care in public hospitals to the one currently provided in the private sector, but the method he wishes to employ will only drive away skilled healthcare professionals and dissuade new doctors and nurses from working in South Africa. Instead, government should let those who can afford it, to pay for private healthcare, and focus on up-skilling and improving the quality of care provided in the public sector. 

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